An Old Man's Liver Harbors Hundreds of Tapeworms

Unbeknownst to him, the patient has hosted a huge colony of larval tapeworms for decades.

What would you do if you had huge parasitic cysts? That could burst at any moment? And spill thousands of babies?

My new patient, an elderly Armenian who recently moved to the United States, didn’t speak much English. He didn’t need to. His penetrating gaze — anxious, wary and pleading all at the same time — revealed his inner thoughts. He had one overriding goal: to make his problem go away ASAP.

I also wanted to vanquish his parasitic invader and restore his peace of mind. But major abdominal surgery in a man nearing 80? About that, I wasn’t so sure.

After trading emails with a local radiologist, I was finally meeting Mr. Kazaryan face to face. From his CT scan, I already knew the bulging landscape of his liver. His X-rays revealed a textbook case of Echinococcus granulosus, or dog tapeworm infection. Within two huge sacs (called hydatid cysts) that occupied two-thirds of his liver, Kazaryan harbored hundreds, if not thousands, of budding tapeworm larvae. In my 30 years as an infectious diseases specialist, I had never seen such a huge cache of parasites.

“Is it true you’ve never experienced any discomfort?” I asked, marveling at the scope of his infection. Yes, he nodded, until a few weeks earlier when an internist discovered his massive, rubbery liver. At that point, Kazaryan started to suffer fretful, sleepless nights — not, as far as I could tell, from physical pain. Just old-fashioned fear.

I clipped Kazaryan’s X-ray films to the light box in my consultation room. Moments later, he and his wife and their daughter-in-law, who was his translator, huddled close as I pointed out the two watery gray-and-white silhouettes in his liver. The largest shadow was as big as an eggplant. Its nearby satellite resembled a ring of bell pepper. Scattered through the remaining tissue were other dots and blots. Were they more larvae waiting to bloom? I wished I knew.

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